Carrier Profile Form
**THIS PAGE MUST BE COMPLETED IN ITS ENTIRETY**
First and last name
Toll Free Phone Number
If No, Projected Compliance Date?
President or owner’s name:
Insurance Phone #:
Insurance Fax #:
Please Provide an Equipment list so that we may better serve your company. (i.e. Power Units, Drivers, Vans, Flatbeds,Trucks, etc.)
Please be sure to enter the quantity of each item
Please list preferred areas for operation
Carrier Name MC #
Please mark all services that apply.
Other Services not listed
DOT/FMCSA Safety Compliance
As a condition of contracting with H.D. White Logistics, LLC to transport freight for its shipper customers, you are required to provide assurance of your compliance with DOT and FMCSA safety regulations including, but not limited to, 49 C.F.R. Parts 382-396. The purpose of this letter is to specifically request your written confirmation that you are, and will
continue to operate, in compliance with all safety requirements of U.S. DOT and FMCSA during the term
of your agreement with H.D. White Logistics, LLC.
DOT and FMCSA safety compliance includes, but is not limited to, carriers following a written safety plan which addresses the following:
1. No drivers are currently employed or will be employed who:
a. Have more than three moving violations in the past twenty‐four-month period.
b. Have been cited for causing a fatal accident
c. Have violated or violate any drug or alcohol testing regulation
Carrier compliance with:
a. Inspection, repair, and maintenance file on all equipment showing compliance with Federal regulations
b.Carrier must not have a FMCSA Safety Rating of “Unsatisfactory” or “Conditional” and agrees to notify H.D. White Logistics LLC immediately if carrier’s safety rating changes to “Unsatisfactory” or “Conditional”.
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